Hospital complications among older adults: Better processes could reduce the risk of delirium

Valdery Moura Junior*, M. Brandon Westover, Feng Li, Eyal Kimchi, Maura Kennedy, Nicole M. Benson, Lidia Maria Moura, John Hsu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37–1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.

Original languageEnglish (US)
Pages (from-to)154-163
Number of pages10
JournalHealth Services Management Research
Volume35
Issue number3
DOIs
StatePublished - Aug 2022

Funding

Keywords

  • access/demand/utilization of services
  • aging
  • clinical practice patterns
  • geriatrics
  • health care organizations and systems
  • hospitals
  • integrated delivery systems
  • mental health
  • quality of care/patient safety

ASJC Scopus subject areas

  • Health Policy

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